China’s war on drugs: From incarceration to rehabilitation

Even a square like Wáng Hùníng 王沪宁 could smell it in the air in 1988 — if not the solvent smell that filled tenement hallways or the columns of haze rising from college quadrangles, then certainly the bitter tang in the breeze of full-blown moral panic. He arrived for his American tour at the moment that the country decided it was time to abandon the libertinism of the previous decade. These were the years of “Just Say No” and the Anti-Drug Abuse Act, Nancy Reagan and Len Bias, inner-city shootouts, and CIA cocaine conflict on the edge of the empire.

In America Against America (美国反对美国 měiguó fǎnduì měiguó), the book Wang wrote about his visit to the United States, drugs made fourth place on his list of American social ills, placing behind only the breakdown of the family, widespread stupidity, and juvenile delinquency.

“I fear that illicit drugs are a force far greater than any historical shocks absorbed by the country,” he wrote. “Facing the problem of unchecked proliferation of narcotics will be a test of the social system and even the moral spirit of the country.”

Wang was overstating it; thirty-five years later, drugs have proliferated, but the country’s “moral spirit” has been disrupted by far worse, from partisan politics to a resurgence of racist rhetoric, the same kind that Reagan and his ilk used to fight the “war on drugs.”

And there was also this: Wang was probably unaware that his own country was about to undergo similar trials “of the social system and even the moral spirit of the country.” While he was touring America, heroin in large quantities was flowing from the Golden Triangle into China’s southern borderlands for the first time since the 1940s, touching off an epidemic of addiction. The first cases of HIV/AIDS were being picked up among intravenous drug users in Yunnan. A documentary broadcast in prime time shocked the nation with footage of young men dead in the dirt or catatonic in tumbledown shacks from potent Burmese heroin. Organized crime groups, armed with weapons diverted from People’s Liberation Army forces fighting the border war with Vietnam, controlled entire towns. Borderlands chaos could not be contained. The number of addicts in southern provinces began to swell.

As Wang ascended to a position advising the post-Dèng Xiǎopíng 邓小平 leadership, these problems worsened. Triple epidemics of heroin, HIV/AIDS, and poverty roiled southern provinces. Drugs began to circulate in the new markets, provided by the hundreds of millions of workers set loose to make a living in the cities of the Pearl and Yangtze River deltas. There were fresh outbreaks of methamphetamine, MDMA, and ketamine abuse.

The People’s War on Drugs (人民禁毒战争 rénmín jìndú zhànzhēng), launched in 1990 and waged, as in America, with police raids, school assemblies, and television commercials, was not successful. According to the 2001 edition of China Drug Control Report, based on the number of people that came into contact with law enforcement for drug crimes but were not registered addicts, there were approximately 25,900 new drug users discovered in the previous year. The number of registered drug addicts crested to 2 million in 2013, and seemed bound to hit 3 million, maybe 4 million. Those limited official numbers — only counting drug users picked up by the Public Security Bureau (PSB) — suggested that there could be millions more uncounted.

Even if America was way out ahead, China’s inability to contain its more modest drug epidemic put it on the same road. But then something changed. In China, the number of new users began to drop dramatically. The number of registered drug addicts has declined every year since 2016. HIV/AIDS cases in the heroin hot spot of Yunnan began a downward trend. The quantity of drugs seized each year decreased. Wastewater-based epidemiology, which monitors illicit drug metabolites in urban sewage systems, confirmed that drug use was down in the cities.

How did this happen? It was not, as former president Donald Trump speculated, because China executed illicit drug manufacturers and traffickers. Turns out the answer was obvious — and accessible to American politicians from the start, if only they cared to look.

A different way of fighting drugs

A young man is spotted by Public Security Bureau (PSB) cops outside a dance hall in Dalian (or a train station in Kunming, a flophouse in Ruili, a KTV in Kaifeng…) — and for whatever reason, he seems suspicious. Maybe the cops just have a hunch. Maybe they notice track marks on his arms or see him exiting a building they have under surveillance. That’s enough for them to initiate an investigation and arrest. He doesn’t have any contraband on him, but a urine test confirms recent use. Once the test comes back, the PSB will register him as an addict and enter his biometric data into the Drug User Dynamic Administration and Control System (吸毒人员动态管控系统 xīdúrényuán dòngtài guǎnkòng xìtǒng), an online database introduced in 2006 for tracking users and addicts. After that, he will be detained, then placed into a rehabilitation program.

The present system should — ideally, according to relevant laws and regulations, discounting individual or systemic corruption or laziness — function something like this.

Drug use is treated as a public security violation rather than a crime, so the young man in this case will not go before a judge. The Public Security Penalties Law (治安管理处罚法 zhìān guǎnlǐchùfǎ) allows detention in serious cases of a minimum of 10 and a maximum of 15 days and a fine of 3,000 yuan ($430). A more pedestrian case, like that of the young man picked up for loitering, never registered as an addict, allows for a shorter term of detention — five days at most — and a fine of 500 yuan ($70). The Drug Control Law (禁毒法 jìndúfǎ) provides guidance on the next step, which is enrollment of the addict into a tiered treatment system.

The first tier is community rehabilitation (社区戒毒 shèqū jièdú), which is also open to any addicts that voluntarily enroll. Treatment begins with physiological detoxification, which can involve substitution therapy, followed by a period of intensive counseling, and then a mental, physical, and ideological rehabilitation program. Three years of ongoing outpatient treatment are mandatory, during which users will be routinely tested. These programs, operated since 2008, look much like drug treatment programs anywhere else, with the same fads for mindfulness and virtual reality.

The next tier is compulsory segregated detoxification (强制隔离戒毒 qiángzhì gélí jièdú), which is ordered according to standards laid out in the Drug Control Law. In recent years, the number of addicts sent to these facilities has declined. Grounds for being locked up for rehab include refusal of community rehabilitation, use of drugs during ongoing or previous community rehabilitation, and repeated offenses by those with a criminal history. A one-year stay is mandatory, but this can be extended up to two years. Apart from detoxification, psychological, physical, ideological rehabilitation, and vocational training, the law allows for detainees to be assigned work, for which they are remunerated.

The crucial difference between the Chinese drug war and the American drug war lies not in cruelty, but in compassion. 

The crucial difference between the Chinese drug war and the American drug war — or the Chinese war back then vs. now — lies not in cruelty, but in compassion — a paternalistic and occasionally oppressive compassion, but one in which users are not incarcerated. Drug traffickers and clandestine chemists face lethal injection, but addicts are taken off the street, registered, put in compulsory treatment programs overseen by medical professionals, and then subject to ongoing monitoring.

Compassion, in various forms, has been at the root of novel addiction treatment modalities. Whatever the approach, it comes down to reversing the stigmatization of drug users — by those who treat them, who experience those feelings with great potency, as well as by users themselves, who have absorbed the perception of the drug addict as biologically or morally flawed untouchables. In Lisbon, Portugal, formerly the heroin capital of Europe, the drug epidemic was solved in part by publicly funded rehabilitation facilities that emphasized the tolerant and merciful treatment of addicts. Compassion is the foundation of harm reduction programs in the European Union, where civil society has been successful in advocating for decriminalization, prescription delivery of heroin and cocaine, and the creation of safe consumption sites. Destigmatizing addiction and compassionate treatment of addicts is arguably what has saved Europe from its opioid crisis.

China’s system, however, is imperfect, arrived at after a long period of brutality. The lesson of the 1980s to the early 1990s, of rounding up suspected drug users in five-ton military trucks, dumping addicts in labor camps to go through withdrawal on a production line, and shackling men together in makeshift detoxification facilities, was that arbitrary, harsh punishment does not alleviate social chaos. The answer is not to push the addict away, but to — very firmly, until they feel as if they might suffocate — hug them to the bosom of the state.

“Looking back to the 1980s, drug treatment policies have changed a lot,” says Yang Jie, a social worker and drug rehabilitation policy researcher in China. Part of this, Yang says, is due to the shift in drugs of abuse: Addicts are increasingly not only using heroin or methamphetamine but also combining illicit drugs. “The current situation is different,” Yang says, “as it’s not clear how to provide evidence-based treatment for people using polydrugs.” While substitution therapy (buprenorphine or methadone are prescribed) works well for heroin addiction, public security organs and social workers have had to experiment with different approaches.

China seems to provide proof that this humane but strict treatment can be more effective than lengthy prison sentences or waiting for addicts to expire in the gutter. This is true both for the health and well-being of people with drug problems as well as public order.

This radically different approach to the treatment of addicts comes from pragmatic study of foreign best practices, local experimentation, the Marxist-Confucian harmony promoted by Hú Jǐntāo 胡锦涛, but also an idea about drug dependency that calls back to the Century of Humiliation (百年国耻 bǎinián guóchǐ), when China itself had to be freed from the shackles of addiction, and an explicitly political approach to rehabilitation that comes from the early days of Liberation.

A rocky history of rehabilitation

This tiered system, with community rehabilitation as the foundation, did not come out of nowhere. It is a somewhat recent innovation, planned as an alternative to previous compulsory treatment regimes, pieced together mostly during the 1980s panic over rising street crime, moral decay, and drug use, when public security organs made use of 1950s-era laws to dump offenders into the reeducation through labor system (劳动教养 láodòng jiàoyǎng). This practice of mass detention worked in earlier campaigns, when social chaos was less widespread, but it failed to solve the problems the PSB faced in the reform and opening years.

In the 1990s, the Ministry of Public Security sought changes to administrative punishments. A new approach to compulsory treatment was provided by the National People’s Congress Decision on Drug Enforcement (全国人民代表大会常务委员会关于禁毒的决定 quánguó rénmín dàibiǎo dàhuì chángwù wěiyuánhuì guānyú jìndú de juédìng). This document proclaimed that reeducation through labor should be used only for recidivists, and that they should be confined in facilities in which drug users could be segregated from other detainees; compulsory rehabilitation was to be provided to all other addicts.

Given the political environment of the time and the hunger for market solutions, compulsory rehabilitation facilities were frequently run as joint public-private enterprises. The influx of inexperienced or predatory private partners led to mismanagement and exploitative practices, which included charging fees to detainees and keeping them longer than required (the state was billed for this). In 1995, the situation was reversed by two decrees, the Ministry of Public Security Notice on Rectification of Drug Rehabilitation Facilities (公安部关于清理整顿强制戒毒所的通知 gōng’ānbù guānyú qīnglǐ zhěngdùn qiánghì jièdúsuǒ de tōngzhī) and the State Council Decision on Measures Concerning Compulsory Drug Rehabilitation (国务院强制戒毒办法 guówùyuàn qiángzhì jièdú bànfǎ), which said only the state could run rehabilitation facilities and that most addicts should be diverted from reeducation through labor.

Returning the system to complete administration by the state introduced new problems, however. Funding was rarely adequate. Training was limited. Facilities were often makeshift, sometimes just a couple of rooms in a detention facility (拘留所 jūliúsuǒ) set aside for the purpose. Since there was often nowhere else to send them, a large number of addicts were still dropped into the reeducation through labor system. There seemed to be no end to the flood of addicts into PSB custody. Figures released in the annual China Drug Control Report suggest a steady increase in new detainees through the 2000s. At that point, things began to break down. The system failed to rehabilitate many. Local and international NGOs criticized human rights abuses in the system. Detainees reported wretched conditions and long hours of labor with remuneration.

The Drug Control Law, passed in 2008, gave clearer limits on who could be sent for compulsory segregated detoxification. This system has been subject to ongoing reform.

This system did not do what it was intended for — rehabilitating people with drug problems — and clearly did not accord with new thinking on rule by law (法治 fǎzhì) or the goals of Hu Jintao’s Harmonious Society (和谐社会 héxié shèhuì). Undefined police powers were a relic of an earlier time. Strike hard (yándǎ 严打) was being phased out in favor of balancing severity with punishment (宽严相济 kuān-yán xiāngjì). The rehabilitation facilities and reeducation through labor camps were also out of step with scientific thinking, ignoring updated addiction treatment modalities and harm reduction strategies.

The reliance of the PSB on reeducation through labor also presented a major problem: The entire system was on the verge of being abolished, which meant the closure of conventional facilities, as well as those converted for exclusive use by drug rehabilitation detainees (these were occasionally reopened as compulsory segregated detoxification but required extensive reorganization and refurbishment).

The Drug Control Law, passed in 2008, was intended to correct all of this. The law mandated supervision of facilities by the Health Administration Department and gave clearer limits on who could be sent for compulsory segregated detoxification. Some basic legal protection was extended to addicts undergoing treatment as well. Although they still had no right to challenge their status or their detention, they had — on paper, at least — protection from abuse and exploitation by staff. This system has been subject to ongoing reform since 2008, with new measures being released on an almost yearly basis to push for professionalization and rationalization.

The next question is whether or not it is more effective. Judging by the number of addicts, the amounts of drugs seized in the country, and wastewater-based epidemiology, fewer people are using drugs. But are these programs actually effective for individual users? It is hard to find numbers to make an informed comparison. The existing numbers are difficult to rationalize. Even if they have been through the same system, it is difficult to generalize the outcomes for heroin users in rural Yunnan, methamphetamine users drawn from migrant workers in Shenzhen, and methcathinone users in Henan.

The baseline for comparisons against the past are usually Yunnan-based studies from the 2000s, since it was the epicenter of the drug problem and produced the most research. There, the problem was heroin, and the relapse rate was high: It may have sat somewhere around 90%. By comparison, a 2018 survey of addicts in Guangxi, Fujian, and Hainan found a 75.3% relapse rate within 30 days of leaving the program. A 2021 study of 337 addicts that had undergone compulsory segregated detoxification found a relapse rate of 54.9%. These are hard to compare against Yunnan studies, since, again, they involve addiction to other drugs (the former study involved use of opiates and methamphetamine, and the drug of choice in the 2021 study was methamphetamine), distant regions, and very different social orders.

The renovated system, together with harm reduction programs, like needle exchanges and methadone maintenance programs, seems to have shrunk the number of drug addicts — or at least doesn’t exacerbate the problem, as the former drug rehabilitation scheme likely did. The total of registered drug addicts now stands at around a million and a half, down from its peak a decade earlier.

Problems caused by big data

The system is opaque, however. Numbers are not wholly reliable. Reports from public security organs admit that many more addicts don’t make official rolls. Leaving it up to PSB oversight means that a drug user can be detained, registered, and sent to compulsory treatment without evaluation by an addiction specialist or doctor. It’s possible that addicts are not only undercounted but in some cases over-counted. Some in the system are not addicts at all but might more accurately be classed as recreational users.

An arbitrary, opaque system leads to abuse, which is a problem especially for those that have left the rehabilitation portion of the program. Registration as an addict means ongoing surveillance. All uses of an identification card, for example, such as for booking a train ticket or a hotel room, or accessing government services, send an alert to the local PSB. Urine and blood tests can be demanded at any time.

The 2009 Measures Concerning Registration of Drug Users (吸毒人员登记办法 xīdú rényuán dēngjì bànfǎ) was intended to clarify this system of registration, which was built off legal precedence from the cleanup of prostitutes and drug addicts in the 1950s. Although it was planned as a supplement to the Drug Control Law, laying out precisely who should be counted as an addict, it still left the decision in the hands of the PSB. There is unclear guidance for induction into the program, but also exit from it. To be removed from the list of registered addicts requires proving abstinence for three years with compulsory follow-up counseling and urine or blood tests.

Those that have met criteria to get off the list find that records are persistent. Some recovered addicts have reported being harassed for nearly a decade since they should have been granted freedom. Data management and security at public security organs is notoriously lax. With a new digital layer added in the form of the Drug User Dynamic Administration and Control System and the dispersal of data across multiple systems, it can be hard to extricate someone from the network of enhanced digital surveillance.

This registration system discourages addicts from being contacted by the PSB in the first place, or after they have ended compulsory treatment. For addicts that need help, registration is required to access free treatment, including community rehabilitation and methadone programs, but fear of lifetime surveillance keeps many away.

Reform of this system is ongoing, but, like seemingly all aspects of governance in China today, the solution is accelerating digitalization. Local experiments are now bound by use of the Drug User Dynamic Administration and Control System and grid-style social management (社会网格化管理 shèhuì wǎnggé huà guǎnlǐ), in service of cybernetic monitoring. Digital surveillance methods are being rolled out, including GPS-enabled bracelets and mobile phone applications tied into PSB networks.

Criticism in local media, with the system referred to as “a set of invisible shackles” (一把无形的枷锁 yībǎ wúxíng de jiāsuǒ), is hopeful. It might signal changes to the system, although it remains to be seen if the search for strictly digital solutions can be abandoned.

China’s historical perspective on narcotics

The system of management for drug addicts will be reformed. This process has been underway since the 1980s. Ideally, pragmatic planners will be able to fix the unproductive and excessive elements, as they have in the past. But the spirit of the management system will not change.

While certain elements of the current anti-drug system, like registration, have their roots in Soviet practices, or adopt methods from the United States, the philosophical approach and the conception of addiction comes from the experience of China in the late-19th and early-20th century.

The Opium War and the trafficking of drugs by foreign forces is central to the Century of Humiliation, and so also central to the founding myths of the People’s Republic of China. China was hooked on dope and exploited; the drug addict, too, is a victim. Drug traffickers are ghouls and murderers, so there is no reason not to execute them, but drug addicts are victims of an evil temptation that no man can resist. The drug addict is incapable of looking after themselves and must be liberated, just as China herself was in 1949.

When the Communist Party began its anti-opium drive in the cities, it recognized addiction as a social and political outcome, the result of a corrupt political system and the assault of imperialism. Dealers were given harsh penalties, while employees of their enterprises were treated leniently; addicts, of which there were an estimated 20 million, were registered and then dispatched for treatment, which involved supervised abrupt detoxification in extreme cases and simply going cold turkey with the help of household or community members. Addicts that had been through the process were invited to speak out at mass rallies, sharing their struggle against the last vestiges of foreign imperialism and the old society (旧社会 jiù shèhuì). The 1952 Directive on Drug Prohibition Propaganda Work (关于禁毒宣传工作的指示 guānyú jìndú xuānchuán gōngzuò de zhǐshì), passed down to frontline workers, made clear that the emphasis should be on political rebirth for addicts, the patriotic struggle against foreign powers, and the connections between drug traffickers and reactionary forces.

The decision to take drugs, as well as the inability to kick the habit, was never framed, explicitly or implicitly as in American addiction discourse, as a moral failing. This has also led to resistance in addiction treatment circles in China to the idea, which has gained ground in other parts of the world, of addiction as a chronic brain disorder.

The methods that the rehabilitation system employs have changed, but the spirit has remained the same since 1949: addicts are the responsibility of the state, who should treat them as victims, give them rehabilitation, grant them a chance at social and political rebirth, and then monitor them. Although this registration and ongoing monitoring process now involves networked databases and GPS, it is essentially an upgrade of the 1952 advisory for addicts to “accept the supervision of the masses” (接受人民群众的监督 jiēshòu rénmín qúnzhòng de jiāndū).

The fact that illicit drugs still mostly flow in from foreign countries gives weight to the ongoing patriotism of the drug war. Harsh crackdowns mean that illicit drug production has declined in China, as has diversion of legitimate pharmaceutical supplies, so heroin, methamphetamine, and ketamine mostly move across southern borders. Drugs can still be constructed as a foreign ill, just as they were in 1949.

What can the U.S. learn from China’s war on drugs, and vice versa?

Since Wang Huning’s visit in 1988, more than a million Americans have died of drug overdoses. Many times more than that have been killed or had their lives shortened by addiction. The cost to the economy can be roughly calculated (it’s in the hundreds of billions of dollars a year), but the social and psychological toll is unknowable.

Drug overdose deaths for the same period in China are difficult to find. There is no national data set. The Ministry of Health lumps illicit drug overdoses under general poisoning deaths, and the numbers from Disease Surveillance Points (国家疾病监测点 guójī jíbìng jiāncè diǎn) don’t rationally separate accidental prescription or over-the-counter drug overdoses with illicit drug deaths. To arrive at a number requires combining surveys of those numbers, evidence from Public Security Bureau records of unnatural deaths, and cohort studies. The conclusion after looking through those numbers is that, if only compared to the United States, fatal drug overdoses are rare.

A 2021 survey found a 49% lifetime prevalence for illicit drug use among Americans. Pān Suímíng 潘绥铭, a sex researcher at Renmin University, after looking at all of the official numbers and bringing in his experience with sexual minority communities (who tend to use illicit drugs at a higher rate), arrived at a figure of 26 million people between the age of 20 and 49 having tried drugs in their lifetimes by 2014, which would be a 0.03% lifetime prevalence for the age group.

There are other factors that can’t be discounted in this comparison: China is less wealthy and less urban; illicit drug use in the years from 1949 to 1979 was, if not completely nonexistent, then isolated; and progressive attitudes toward drugs never took root.

The decision to take drugs was never framed, explicitly or implicitly as in American addiction discourse, as a moral failing.

If China’s approach has succeeded, very little of it seems applicable to the United States. The struggle against fentanyl cannot be solved by addicts denouncing foreign drug traffickers at rallies. If the federal or any state governments managed to fund compulsory rehabilitation, it would not survive a legal challenge. In places like California, where small minorities have been campaigning for mandatory treatment, there has been little progress in that direction. The tools the Chinese state uses to fight drugs are not available to Americans.

If the United States’s approach to its drug problem has failed, it might, however, still be more than a negative example for Chinese bureaucrats. This is the lesson of America Against America — a book that is never completely pessimistic about its subject, and always looking for admirable aspects of American culture.

The legal framework that makes compulsory drug rehabilitation impossible in America cannot be adopted wholesale in China, but it might be referred to by reformers of the addict registration system. The right to challenge one’s enrollment in the rehabilitation programs or networked databases would go a long way to improving the system.

Harm reduction advocates in the United States have battled fierce resistance, but they are still ahead of China. While methadone maintenance clinics and needle exchange programs have appeared in Chinese cities, they are limited. Naloxone distribution has not been undertaken with any seriousness. The reaction to foreign safe injection sites in the media suggest they would be a tough sell, but that does not mean there is no way to integrate a modified version into the Chinese system.

On the question of drugs and addiction, as with many other social problems, like rural poverty, domestic violence, and street crime, the vast difference in approaches between the United States and China should not be an excuse to declare that there is nothing to be learned, but an invitation to borrow and modify approaches that are worthwhile.